Dual plating provides better coronal alignment in femoral periprosthetic fracture cases

In their recent study, Andring et al. and colleagues concluded that dual plating for distal femoral periprosthetic fractures ensures good coronal alignment and low reoperation rates even in patients with immediate weight bearing. The patients regained baseline level of ambulation more reliably when compared to those treated with a single distal femoral locking plate.

This study is published in the Journal of Orthopaedic Trauma.

The present study described an experience with the DP construct. The study design and settings included a retrospective case series with a comparison group and a Level 1 academic trauma centre.

The selection criteria for patients in this study involved adults over 50 with sustaining comminuted OTA/AO 33-A2 or 33-A3 DFPF fractures. These cases were treated with either DP or a single distal femur locking plating (DFLP). Patients with simple 33-A1 fractures were not included in the study. Before 2018, DFLP was the preferred treatment and patients were treated with this method, but DP has become the treatment choice since then. The Outcome Measures and Comparisons included reoperation rate, alignment, and complications.

The results from this study are:

• Thirty-four patients treated with DFLP and 38 with DP met inclusion and follow-up criteria.
• The average follow-up duration in DFLP and DP groups was 18.2 ± 13.8 months and 19.8 ± 16.1 months, respectively.
• The average patient age in the DFLP and DP groups was 74.8 ± 7.3 years and 75.9 ± 11.3 years, respectively.
• No difference was reported in demographics, fracture morphology, loss of reduction, or reoperation for any cause.
• Compared to DFLP patients, DP patients were more likely to be weight-bearing in the twelve-week postoperative period and return to their baseline ambulatory status.

Dual plating of distal femoral periprosthetic fractures maintained coronal alignment and low reoperation rates even with immediate weight bearing. Patients regained ambulation (baseline level) more reliably than those treated with a single femoral locking plate. The LEVEL OF EVIDENCE was Therapeutic Level III.

Reference:

Andring et al. Dual Plate Fixation of Periprosthetic Distal Femur Fractures. Journal of Orthopaedic Trauma 38(1):p 36-41, January 2024